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nataliexdean's profile
Natalie E. Dean, PhD
Natalie E. Dean, PhD
Natalie E. Dean, PhD
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@nataliexdean

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Natalie E. Dean, PhDVerified account

@nataliexdean

Asst Professor of Biostatistics at @EmoryRollins, specializing in emerging infectious diseases and vaccine study design. Previously @UF @HarvardBiostats.

Emory University
nataliexdean.com
Joined June 2018

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    Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

    THINK LIKE AN EPIDEMIOLOGIST: What does it mean that the median age of new cases is dropping in some areas? I see three possible explanations, not all good. A thread on how to distinguish between them. 1/10 (Figure h/t @ScottGottliebMD)pic.twitter.com/Y6m45qoBL6

    7:13 AM - 23 Jun 2020
    • 4,039 Retweets
    • 8,490 Likes
    • Amir-Hossein Karimi Luis Saldana John Gordon MD Mollie Hooper Amer Zeidan, MBBS, MHS Marc MacConchradha Simon Statsfolio Fanny Fradette MarkQuarter
    205 replies 4,039 retweets 8,490 likes
      1. New conversation
      2. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        Explanation 1: More testing. As we do more testing in the community, we are able to capture more mild or even asymptomatic infections. This is especially true for routine workplace testing. As younger people have milder disease, this shifts the age distribution lower. 2/10

        15 replies 109 retweets 1,204 likes
        Show this thread
      3. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        If median age drops because of more testing only, we expect: - Increase in number of cases detected across all age groups - Test positivity to drop in all age groups (size of drop depends on which groups are targeted for testing) - No change in hospitalizations 3/10

        11 replies 106 retweets 1,022 likes
        Show this thread
      4. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        Explanation 2: Elderly people are more cautious. Median age could also drop if the elderly were protecting themselves better, even with no change in testing. For example, we are preventing more nursing home outbreaks. 4/10

        11 replies 97 retweets 1,105 likes
        Show this thread
      5. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        If median age drops only because the elderly are more cautious, we expect: - Drop in number of new cases in the elderly - Drop in test positivity among the elderly (fever/illness is more likely due to other non-COVID causes) - Drop in hospitalizations (after a lag) 5/10

        5 replies 82 retweets 906 likes
        Show this thread
      6. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        Explanation 3 (the not good one): Young people are less cautious. This is distinct from the previous scenario. It means that young people are being infected even more than before. This could occur if there are many bar/nightclub or workplace outbreaks. 6/10

        40 replies 153 retweets 1,323 likes
        Show this thread
      7. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        If median age drops only because young people are being infected more, we expect: - Numbers of new cases to rise in young people - Test positivity to increase in young people - More young people being hospitalized (after a lag) 7/10

        6 replies 108 retweets 939 likes
        Show this thread
      8. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        Besides the fact that young people can face unknown long-term outcomes of infection, they can also inadvertently spread the virus to their communities. So the median age could start to creep back up if it moves from bars out to coworkers, family members, etc. 8/10

        14 replies 176 retweets 1,143 likes
        Show this thread
      9. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        The reality is almost certainly some mixture of all three explanations. In this figure (h/t @trvrb), test positivity drops for everyone (more testing), but most in the elderly (more protection). But it is flatlining in 18-49 y/o and could start increasing (more infection). 9/10pic.twitter.com/t8tSUg3scL

        22 replies 198 retweets 1,240 likes
        Show this thread
      10. Natalie E. Dean, PhD‏Verified account @nataliexdean 23 Jun 2020

        Ultimately, we need more high quality age-stratified data on cases, testing, and hospitalizations. These are my preliminary thoughts on how to distinguish between these scenarios. Looking forward to discussing with #epitwitter more! 10/END

        100 replies 167 retweets 1,825 likes
        Show this thread
      11. End of conversation
      1. New conversation
      2. Sarah Lewis, MSW, PhD‏ @iamsadielumus 23 Jun 2020
        Replying to @nataliexdean @cmyeaton @ScottGottliebMD

        Even more disturbing- mild symptoms may lead to long term lung damage. We have no idea what other long term effects...

        4 replies 8 retweets 181 likes
      3. Jason Gallagher‏Verified account @JGPharmD 23 Jun 2020
        Replying to @iamsadielumus @nataliexdean and

        That would be disturbing, but I’m not aware of any data suggesting it. Are you? IMO (and just an opinion) it seems unlikely.

        13 replies 0 retweets 11 likes
      4. Show replies

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